The young man, age 23, approaching you along the swirling edge of the Green River, looks like something from The Twilight Zone, a dimension in which normal human anatomy has been altered. His right cheek is swollen to an astounding roundness, pulling his lips into a grimace, almost shutting his right eye. Oh yeah, you remember, vaguely, the face. Last night it was complaining of a toothache. A peak inside the mouth this morning reveals a dark and forbidding bulge of the gum. Your medical mind, honed to a keen edge by a recent Wilderness First Responder course, chants a litany of dental problems:

Where a filling has fallen out or a cavity has developed, pain usually first occurs when cold, food or the owner's tongue hits the spot. After rinsing the area clean, you know a drop of oil of cloves (eugenol) will ease the pain. A temporary filling is the best treatment until a dentist can be found. Cavit® is the easiest to use and best temporary filling material. Just fill the hole with Cavit®, bite to align with the teeth above, and wait until it hardens. A temporary filling can be made from mixing zinc oxide powder and eugenol. To improvise, you can fill the cavity with candle wax, ski wax or sugarless gum. Temporary filling material can also be used to hold a dislodged crown back in place.

If a tooth is knocked out, there is a small chance it can be salvaged if you can get it back in the hole from whence it came. After rinsing the tooth off (do not scrub it), press it gently back in. If it won't go back in, at least save it until you find a dentist. Same goes for a broken off piece of tooth.

When a broken tooth exposes the pulp, pain can be extreme. A small piece of aspirin placed directly on the exposed pulp causes a burning pain but "cauterizes" the pulp, putting an end to the patient's distress for a while. Never put aspirin on the gum next to an aching tooth. Acid in aspirin will burn the gum. Have the patient swallow the aspirin, or another painkiller, if you need to offer further relief.

Any bleeding inside the mouth can be given direct pressure with a gauze pad held in place with your finger or bitten in place with your teeth. A moistened non-herbal tea bag can be used instead of gauze-the tannic acid in tea initiates clotting. Tell the patient to avoid irritating a wound in the mouth: no smoking, no chewing on the "bad" side, no hot foods, no sucking on the wound.

An infected tooth is indicated by a lot of swelling in the gum near the tooth and the cheek. Aha! Discoloration may be visible inside the mouth. More aha!! This patient needs a dentist as soon as possible. Cold packs on the cheek may give some relief. A strong painkiller will probably work better. If evacuation is delayed, have the patient rinse her or his mouth several times a day with warm, salty water. It would be best to start the patient on an oral antibiotic.